Individual
CONNIE LOUISE WADHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, LMSW
Contact information
Practice address
3613 WILLIAMS DR STE 304, GEORGETOWN, TX 78628-1369
(512) 400-4247
Mailing address
3613 WILLIAMS DR STE 304, GEORGETOWN, TX 78628-1369
(512) 400-4247
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
68854
TX
225700000X
Massage Therapist
MT025785
TX
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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